Pregnant women should be able to rely on the NHS for the best available care for them and their babies. But that doesn’t always happen.

I set out to achieve wider use of a proven test to avoid unnecessary ‘just in case’ hospital admissions for suspected pre-eclampsia. Its increased accuracy reliably rules out pre-eclampsia leading to more than 1,000 fewer admissions each year in the Thames Valley region alone. Across the country that means thousands of pregnant women avoid the unnecessary anxiety associated with going into hospital. At the same time maternity services are able to focus more on those women who are at greater risk of developing pre-eclampsia.

Pre-eclampsia is a serious disease that occurs in three per cent of all pregnancies. It is characterised by high blood pressure and protein in the urine. It leads to oedema and can result in organ failure and seizures in the mother. It can lead to restricted growth in the baby and often premature delivery, as delivery is the only “cure” for the disease. The additional cost to the NHS for treating pre-eclampsia is estimated at £9,000 per pregnancy.

Today, pre-eclampsia is diagnosed only by excluding all the other possible causes of high blood pressure and protein in the urine through a series of tests. These take time and cause anxiety for the mother-to-be and her family. Women with suspected pre-eclampsia are often admitted to hospital for observation “just in case”, sometimes for several days.

The new test is changing that approach by providing more information to help with the diagnosis. It was first trialled at Oxford University Hospitals where it has now been introduced as a standard test. The Oxford Academic Health Science Network is now overseeing its introduction into other hospitals in the Thames Valley region and beyond, through the AHSN Network. The test has also been identified for rapid uptake nationally by the Accelerated Access Collaborative which identifies highly transformative innovations and introduces an accelerated pathway to market.

The key has been combining industry innovation and research evidence to meet a known NHS need. That is where the AHSNs came in. The Oxford AHSN’s expertise and connections opened doors and enabled use of this test to spread from an initial hospital to multiple sites. They developed insight into pathways and needs as well as providing project management and business support for adoption.

The Oxford AHSN has forged strong partnerships with Roche Diagnostics who developed the test, and the clinical, laboratory and finance teams in each hospital to deliver tailored solutions.

This is a powerful example of better diagnostics leading to improvements in clinical care and system efficiencies. This was recognised when it won the ‘Best Healthcare Provider Partnership’ category of the HSJ Partnership Awards 2019.

]]>Survey reveals NHS research and innovation prioritieshttps://www.oxfordahsn.org/news-and-events/news/survey-reveals-nhs-research-and-innovation-priorities/
Tue, 07 May 2019 07:31:59 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=9213The findings from a survey to identify local NHS innovation and research needs have been published.

The views of local health stakeholders, including clinical leaders, managers and directors, within each AHSN (Academic Health Science Networks) region were collected through qualitative interviews with 61 people and a questionnaire which received more than 250 responses in total.

The report outlines the national findings from the survey with local health and social care stakeholders. It includes a detailed analysis of the innovation and research needs at local level across all AHSNs.

Whilst there were some differences in regional priorities, common themes emerged which reflected wider challenges facing the NHS and align with the priorities of the NHS Long Term Plan. These include:

a need for innovation and research addressing workforce challenges

delivery of mental health services and providing care for patients with mental health needs, particularly in children and young people

integrating services to provide effective care for patients with complex needs – including multimorbidity and frailty

use of digital and artificial intelligence technology

Professor Gary Ford, Chief Executive of Oxford AHSN, led the AHSNs’ input into the survey. He said: “The survey provides important information on the research and innovation needs of the NHS which will shape future work of AHSNs and the research community.”

The survey was commissioned by the AHSN Network, in partnership with NHS England and the National Institute for Health Research, to support the publication of a statement of local NHS research and innovation needs for each AHSN region – as one of the actions in the NHS England and NIHR joint paper on ‘12 actions to support research in the NHS’.

Further regional discussions will now take place, involving patients, the wider public and the research community, to refine the priorities identified. This consultation will lead to each AHSN region publishing a statement of local innovation and research needs.

The survey was conducted by ComRes, an independent research agency.

]]>Oxford AHSN appoints first medical directorhttps://www.oxfordahsn.org/news-and-events/news/oxford-ahsn-appoints-first-medical-director/
Tue, 02 Apr 2019 08:47:46 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=9170Dr Guy Rooney is to take on the new position of medical director at the Oxford AHSN. He will have a key role in supporting innovation adoption and strengthening clinical engagement with emerging integrated care systems.

Guy, pictured right, is currently medical director at Great Western Hospitals in Swindon where he has worked for almost 20 years. He starts the new role on 10 June.

Professor Gary Ford, Chief Executive of the Oxford AHSN, said: “We are delighted to have a senior clinical leader like Guy joining us. He will help us in many ways, notably in getting more clinical innovations into practice, ensuring they make a difference to patient outcomes, safety and experience at the earliest opportunity.”

Guy said: “I have maintained strong links with the Thames Valley health system over the years and I look forward to developing these through the Oxford AHSN. I’m really looking forward to working with clinicians to improve the healthcare we deliver through innovation and transformation.”

Guy, who will continue to work as a practising clinician, will liaise closely with the Oxford AHSN’s three programmes: clinical innovation adoption, patient safety & clinical improvement and strategic & industry partnerships.

Guy has been a consultant in sexual health and HIV at the Great Western Hospitals NHS Foundation Trust since 1999. In 2009 he became an associate medical director at the trust. He was appointed medical director in 2014 and deputy chief executive in 2016. In that year he also took on the role of medical specialist advisor at Oxfordshire Clinical Commissioning Group.

The prize-winning team from the Oxford AHSN, Oxford University Hospitals and Roche Diagnostics

An initiative bringing together the Oxford AHSN, NHS and industry to improve patient care has won a national prize.

The collaboration with Roche Diagnostics to introduce a new test for pre-eclampsia into maternity units was the winner of the ‘Best Healthcare Provider Partnership’ category of the HSJ Partnership Awards.

The test predicts with much greater accuracy whether a pregnant woman will develop pre-eclampsia within the following seven days. It rules out women who will not develop pre-eclampsia so that they do not have to undergo the worry and inconvenience of an unnecessary hospital stay. It also means that resources can be focused more effectively on the women who really need them.

The test was trialled at Oxford University Hospitals (OUH) where it has now been introduced as standard. The Oxford AHSN is overseeing its introduction into other hospitals. It measures the ratio of two placental factors – maternal serum soluble fms-like tyrosine kinase (sFlt-1) and placental growth factor (PlGF) – that are released into the mother’s blood.

Professor Gary Ford, Chief Executive of the Oxford AHSN, said: “We are delighted that the judges saw how this approach is making a real difference to the lives of many pregnant women. More accurate diagnosis brings many benefits – it reduces the need for admission as well as indicating those women who need closer monitoring. This is a powerful example of improved diagnostics leading to improved clinical care pathways.”

Chris Hudson, Director of Access and Innovation, Roche Diagnostics, said: “Working in partnership with the Oxford AHSN meant the right stakeholders were brought together with a clear plan developed to accelerate the adoption of this innovation. We believe in working with partners in the NHS to transform healthcare and innovations like this can help women receive the right level of care at the right time, which in turn can improve patient safety.”

Dr Manu Vatish, Consultant Obstetrician at OUH and Senior Clinical Fellow with the University of Oxford’s Nuffield Department of Women’s and Reproductive Health, said: “Almost 70 per cent of patients admitted don’t actually have pre-eclampsia. Using the new test together with standard clinical practice, this figure rises to 100 per cent.

“This approach allows us effectively to segregate patients into those who have virtually no risk of getting the disease and those with an increased risk. This test improves our diagnostic accuracy and is a welcome step forward.”

Tim James, OUH Head Biomedical Scientist, said: “The beauty of these tests is that they are not reliant on analysers only available in Oxford. The instruments are available at many hospitals, meaning the benefits can be expanded across the UK relatively rapidly and easily, and pregnant women everywhere should be able to benefit.”

A second Oxford AHSN collaboration was also a finalist in the HSJ Partnership Awards. The work with Bayer and Buckinghamshire Clinical Commissioning Group to cut the risk of stroke was shortlisted in the ‘Best Pharmaceutical Partnership with the NHS’ category. Read more here.

HSJ editor Alastair McLellan said: “The HSJ Partnership Awards highlights the invaluable work performed by the organisations that work alongside the NHS to deliver first class patient care, delivering tangible benefits to NHS patients, clinicians and the facilities they use, making a real difference in these challenging economic times.”

]]>Thousands in Thames Valley helped by free online support for poor sleephttps://www.oxfordahsn.org/news-and-events/news/thousands-in-thames-valley-helped-by-free-online-support-for-poor-sleep/
Mon, 11 Mar 2019 17:06:09 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=9127This Friday (15 March) is World Sleep Day – the perfect day to join the 3,000+ people in Berkshire, Buckinghamshire and Oxfordshire who have already taken advantage of a new free web-based sleep improvement programme: www.sleepio.com/NHS.

As part of the first NHS rollout of direct-access digital medicine, Sleepio has been available free across the Thames Valley since its launch in October 2018 through a unique partnership between the NHS, employers and Big Health, the company behind Sleepio. The project is funded by Innovate UK and led by the Oxford AHSN.

By the end of February 3,286 people had completed a sleep test at sleepio.com/nhs. This test provides a score based on feedback on sleep quality. Those with less severe sleep disruption are directed to a self-help guide while about a third (1,165) with more deep-seated insomnia have started the CBT-based programme.

The Sleepio package, based on digital cognitive behavioural therapy (CBT), is a proven alternative to sleeping pills and can be accessed without having to see a doctor or pharmacist first.

Difficulty sleeping is the most common mental health complaint in the UK – poor sleep affects one in three adults. Insomnia is a chronic disorder affectign 10-12 per cent of working adults. In the Thames Valley almost half a million prescriptions relating to poor sleep are issued every year at a cost to the NHS of over £1.5 million.

A major study led by the University of Oxford and published in the JAMA Psychiatry journal last September found Sleepio led to improved sleep and, importantly, the knock-on health benefits. It also showed that Sleepio could be effective across a large population.

Professor Colin Espie, Oxford University Professor of Sleep Medicine and Sleepio co-founder, said: “Most people who seek help with insomnia do so because of its negative impact on their daytime quality of life. Sleepio’s new form of ‘digital medicine’ is a powerful way to help thousands of people in the Thames Valley not only get the improved sleep they’re seeking, but also achieve better mental and physical well-being as a result.”

Douglas Findlay, who lives in Reading, has used Sleepio to help him to sleep better. He said: “I was sceptical at first but I discovered it is really user-friendly and has lots of practical advice. It’s easily accessible and you can use it when you need it. It tracks your sleep so you can see the improvement. This project offers the opportunity for many more people to access high quality cognitive behavioural therapy which could result in big benefits for a large population.”

Dr Michael Mulholland, a GP in Buckinghamshire and the project’s clinical lead, said: “I see the impact of insomnia on people’s lives every day. Sleepio offers a real opportunity to transform lives for the better and to reduce reliance on sleeping tablets. This collaboration will explore the potential of digital innovations to improve lives.”

]]>Clinicians seize opportunities for shared learning and networkinghttps://www.oxfordahsn.org/news-and-events/news/clinicians-seize-networking-opportunities/
Mon, 11 Mar 2019 13:47:14 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=9125Almost 200 clinicians from across the Oxford AHSN region and beyond came together for three wide-ranging shared learning and networking opportunities.

The longest established are the maternity shared learning events. These began in 2016 with the fifth one held on 27 February. It was run by the Oxford Patient Safety Collaborative with the Thames Valley Strategic Clinical Network and attended by almost 100 people drawn from various maternity and neonatal roles at all hospitals in the Oxford AHSN region.

National speakers included Professor Jacqueline Dunkley-Bent OBE, Head of Maternity, Children & Young People at NHS England and National Maternity Safety Champion for the Department of Health. There were many other contributions highlighting quality improvement and patient safety initiatives across the region.

Oxford University Hospitals’ Chief Nurse Sam Foster, pictured left, was among the speakers at the fourth meeting of the regional emergency department collaborative on 8 March. Set up in 2017, it brings together multi-disciplinary ED teams – along with colleagues in the ambulance service and primary care – to work across services, sectors and specialties. More here.

Surgeons, anaesthetists, intensivists, matrons, specialist nurses, physiotherapists and other senior staff from multi-disciplinary teams in five NHS trusts across the Oxford AHSN region came together on 4 March to continue their shared work to improve care for patients undergoing emergency laparotomy surgery. Colleagues from Swindon, Leeds and Portsmouth also shared their experiences during the meeting.

Started in 2018, this is one of seven national programmes for spread and adoption championed by all AHSNs. This was the second time the Oxford AHSN emergency laparotomy collaborative had come together. The next meeting takes place on 3 June.

]]>Oxford AHSN shortlisted in two categories of national health-industry partnership awardshttps://www.oxfordahsn.org/news-and-events/news/oxford-ahsn-shortlisted-in-two-categories-of-national-health-industry-partnership-awards/
Thu, 31 Jan 2019 10:03:56 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=9072Two initiatives bringing together the Oxford AHSN, NHS and industry to improve patient care are in the running for a national prize.

The projects are finalists in the HSJ Partnership Awards. The winners will be revealed on 20 March.

A collaboration with Bayer and Buckinghamshire Clinical Commissioning Group to cut the risk of stroke is shortlisted in the ‘Best Pharmaceutical Partnership with the NHS’ category. Read more here.

The Oxford AHSN’s work with Roche Diagnostics to introduce a new test for pre-eclampsia into maternity units is shortlisted in the ‘Best Healthcare Provider Partnership’ category.

Professor Gary Ford, Chief Executive of Oxford AHSN, said: “More accurate diagnosis brings many benefits – it reduces the need for admission for many pregnant women as well as indicating those who need closer monitoring. This is a powerful example of improved diagnostics leading to improved clinical care pathways.”

Chris Hudson, Director of Access and Innovation, Roche Diagnostics, said: “Working in partnership with the Oxford AHSN meant the right stakeholders were brought together with a clear plan developed to accelerate the adoption of this innovation, which can help patients receive the right level of care at the right time.”

HSJ editor Alastair McLellan said: “The HSJ Partnership Awards highlight the invaluable work performed by the organisations that work alongside the NHS to deliver first class patient care, shining a spotlight on their efforts which are often unseen but are essential. Each of the shortlisted organisations is delivering tangible benefits to NHS patients, clinicians and the facilities they use, making a real difference in these challenging economic times.”

]]>Primary care initiative reducing stroke risk in running for national awardhttps://www.oxfordahsn.org/news-and-events/news/primary-care-initiative-reducing-stroke-risk-in-running-for-national-award/
Tue, 22 Jan 2019 17:51:50 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=9054A partnership project which is cutting the risk of stroke in Buckinghamshire has been shortlisted for a national award.

The Excellence in AF (atrial fibrillation) initiative is linked to 17 fewer strokes per year in Bucks, saving three lives and £230,000 annually in direct stroke-related care costs. The project is shortlisted in the ‘Best Pharmaceutical Partnership with the NHS’ category in the HSJ Partnership Awards. The winners will be revealed on 20 March.

Excellence in AF is a collaboration between the Oxford AHSN, Bayer and Buckinghamshire Clinical Commissioning Group (CCG). Professor Gary Ford, Oxford AHSN Chief Executive and AHSNs’ national AF lead, said: “We are delighted that the success of this work to reduce stroke has been recognised.

“It has brought together expertise from primary care, industry and the AHSN to identify people with atrial fibrillation at risk of having a stroke and optimise their care so they are less likely to have one. This has been shown to improve lives to both prevent disability and reduce NHS costs.”

Dr Raj Thakkar, a GP and Clinical Commissioning Director for Planned Care, Bucks CCG, and Cardiac lead at Oxford AHSN, said: “What an honour to be shortlisted! It’s testimony to a great team, committed GP members and Bucks as a system working together to reduce stroke, which is devastating and potentially preventable. Our mission will continue across the Thames Valley, aiming to be best in class.”

The project identified patients at high stroke risk who were not receiving oral anticoagulation therapy. They were then invited for stroke risk counselling at their GP surgery and offered oral anticoagulation therapy where clinically appropriate. Anticoagulation reduces risk of atrial fibrillation (AF), the most common type of irregular heart rhythm and a leading cause of stroke.

Twenty-eight GP practices in Bucks took part in the first phase of the project, with 4,400 of their patients having a detailed review. As a result, an additional 266 patients are now receiving oral anticoagulation, 227 of whom have a high risk of stroke. This equates to up to 17 fewer strokes per annum avoiding approximately £0.23m in stroke care costs annually. Practices were also supported to carry out a quality improvement project to identify areas for sustainable improvement in AF care.

Anticoagulation rates were already relatively high in Bucks so the benefits in other regions could be even bigger.

The project generated both qualitative and quantitative feedback which helped the CCG develop ongoing initiatives to support GP practices.

England’s 15 AHSNs have collectively identified the spread and adoption of AF best practice as a national priority backed by NHS England. They are working together to detect more cases through simple pulse checking and the use of new mobile ECG technology.

About atrial fibrillation and anticoagulation

Atrial fibrillation (AF) is the most common cardiac arrhythmia, estimated to affect around 2.5% of the population. After the age of 40 there is a one in four lifetime risk of developing AF. In a person with AF the irregular action of the heart can cause a blood clot to form in the left atrial appendage. If clots formed in this way leave the heart they can embolise to the brain causing a stroke.

AF causes around one in five of all strokes in the UK. These tend to be more severe than other strokes; the mortality rate is higher and people are more likely to be left with severe impairments that require long-term care. Stroke can have a devastating effect on patients and their families as well as costing the NHS over £13,000 in the first year alone.

Many people are unaware they have AF, and some with known AF do not receive optimal treatment, resulting in avoidable strokes.

One million people in England are diagnosed with AF. A further 400,000 are unaware they have AF, and some with known AF do not receive optimal treatment, resulting in avoidable strokes.

For people with known AF, anticoagulation with warfarin or a direct oral anticoagulant (DOAC) can reduce the annual risk of a stroke by two-thirds. The National Institute for Health and Care Excellence (NICE) recommends that all patients with AF have their stroke risk assessed.

The New Year brought in the long-awaited NHS Long Term Plan. I welcome its commitment to realise the UK’s world-leading research and innovation for the benefit of NHS patients. The plans to simplify national innovation programmes and strengthen links between AHSNs and other regional support infrastructures should speed up the uptake of new products and service pathways and lead to better patient outcomes and improved efficiency. But they will require creation of more headroom and transition funding to support NHS providers in delivering change.

The Long Term Plan sets out to create a digitally-enabled NHS that empowers patients, supports clinicians and increases the productivity and effectiveness of healthcare staff. Our region is well placed to be at the forefront of digital transformation with the Thames Valley and Surrey Local Health and Care Record Exemplar (LHCRE) and three Global Digital Exemplar organisations.

Our own plans and priorities are well aligned with tackling the major causes of premature death which are a focus of the Long Term Plan. I was pleased to see the inclusion of cardiovascular disease and stroke in these, as the implementation of innovative therapies such as thrombectomy brings substantial benefits and long term cost savings to the health and social care system.

Achieving the plan’s goals in multiple areas of service improvement will be a major workforce challenge which will require a clear focus and relentless commitment to the adoption of innovative, flexible approaches to our future training programmes.

The plan is ambitious in seeking to address challenges such as preventing obesity and alcohol misuse. Whilst NHS services can have an impact on prevention, the main levers to change lie with local communities and national regulation, and require the influence and skills local and national government can bring to these challenges. In that context a major test of the evolving integrated care systems, working across NHS partners and local government, will be the delivery of effective prevention programmes.

“A focus on technology has to be our priority, as does the development of our workforce” – Guardian interview with Professor Joe Harrison, Chief Executive of Milton Keynes University Hospital and chair of the Oxford AHSN Research and Development oversight group

]]>Psychological therapies deliver better outcomes for people with long-term conditions and mental illnesshttps://www.oxfordahsn.org/news-and-events/news/psychological-therapies-deliver-better-outcomes-for-people-with-long-term-conditions-and-mental-illness/
Wed, 12 Dec 2018 13:32:39 +0000http://www.oxfordahsn.org/?post_type=ohis_newsarticle&p=8998Treating mental and physical health problems together delivers better patient outcomes and savings for the NHS, according to new analysis.

NHS England plans that by 2020/21 each year over 1.5 million people with common mental health problems will access psychological therapies. These people often also have physical long-term conditions such as diabetes, lung disease and heart problems.

NHS England awarded Improving Access to Psychological Therapies (IAPT) services in the Oxford AHSN region ‘Early Implementer’ funding to lead the way in setting up integrated treatments for patients with long-term conditions (LTCs) alongside mental illness. Four of the first 22 services selected nationally were in the Oxford AHSN region.

These new treatment services are co-located in primary care and delivered in multi-disciplinary teams. IAPT psychological therapists work with colleagues with expertise in fields related to long-term conditions – such as diabetic nurses, cardiac rehabilitation nurses and physiotherapists specialising in chronic obstructive pulmonary disease – to provide holistic treatments.

A rigorous evaluation of clinical and health economics outcomes demonstrated the value of the new approach coordinated by the Oxford AHSN Anxiety and Depression Network working with Talking Therapies in Berkshire, Talking Space Plus in Oxfordshire and Healthy Minds in Buckinghamshire.

This study was carried out by health economist Professor David Stuckler, formerly of the University of Oxford, now based at the University of Bocconi, Italy, supported by NHS South, Central West Commissioning Support Unit. It focused on one of the first groups of patients (more than 450 people) who started receiving new, integrated IAPT-LTC treatments in 2017.

The evaluation concluded that after receiving integrated IAPT treatment patients with LTCs:

reported fewer symptoms of anxiety/depression

made less use of primary and secondary healthcare services*

will save the health system on average an estimated £1,870 per patient over a two-year period (taking into account IAPT treatment costs)

Read more on the findings of the clinical and health economics evaluation here.

Patient feedback

‘After my heart attack I was feeling chest pain and I was going to A&E and hospital but they said I was fine. Then I saw the Heart2Heart therapist and realised I was depressed. I’ve got a long way to go but I can get out of the house now and I am thinking of returning to work.’

‘One of the biggest benefits of the group was the opportunity to meet other people living lives where every day they face the challenges of a long-term health condition. It’s been a huge encouragement.’

‘I feel relieved now that I know how to manage my diabetes better.’

‘I’ve got my bounce back. I’m a lot less angry. I’m a lot less tearful, and feeling much happier in myself.’

Professionals’ feedback

‘We have seen excellent outcomes for patients accessing these joined up services including increased confidence, increased independence and an ability to manage disabling anxiety associated with breathlessness.’

‘The benefits of integrated working are endless. Endless. When mental and physical health services work closely together and collaboratively, we have an accountable care system.’